Tight glucose control cuts risk of diabetic kidney disease

SAN FRANCISCO (Reuters Health) - Maintaining tight control of blood glucose (sugar) in type 2 diabetics reduces the risk of kidney disease by 21 percent, according to results of a study reported at the annual meeting of the American Diabetes Association.

At the start of the study, average hemoglobin A1c - a standard measure of blood sugar -- was 7.5%. Roughly 11,000 patients were randomized to intensive glucose control to reach a target A1c level of 6.5% or lower, or to standard glucose control recommendations.

At an average follow-up of 5 years, average A1c fell to 6.5% in the intensive group compared with 7.3% in the standard group.

"The average difference in hemoglobin A1c during follow-up was 0.7%," Dr. Anushka Patel of The George Institute for International Health in Sydney, Australia, told Reuters Health.

The incidence of severe episodes of low blood sugar was 2.7% in the intensive glucose management group and 1.5% in the group receiving standard care. "However, the overall incidence was really quite low and there were no real sequelae, no evidence of chronic adverse events with hypoglycemia."

There was a 10% decrease in overall heart-related "events," Patel reported, and the risk of kidney disease was decreased 21% with tight blood sugar control.

"We did not find any evidence of an increase in cardiovascular deaths or deaths from all causes," with intensive glucose management, Patel said. This finding is in direct contrast with the findings of another recent study, which was halted early when it appeared that intensive glucose management was associated with an increased risk of death.

"There are some important differences in the two trials that may help explain the difference in results," Patel explained.

The results of the current study, Patel concluded, "suggest that the guideline recommendations for tight glucose control are appropriate."